个案护理英文Word下载.docx
- 文档编号:20584005
- 上传时间:2023-01-24
- 格式:DOCX
- 页数:9
- 大小:165.35KB
个案护理英文Word下载.docx
《个案护理英文Word下载.docx》由会员分享,可在线阅读,更多相关《个案护理英文Word下载.docx(9页珍藏版)》请在冰豆网上搜索。
nursingevaluation-------------------------------------16
Summary------------------------------------------------17-19
Reference------------------------------------------------19
Ⅰ.Introduction
1.theconceptofdisease:
theuppergastrointestinalhemorrhageisreferstotheligamentofTreitzabovethedigestivetract,includingtheesophagus,stomach,duodenumbleedingorbiliousandpancreaticdisease,stomachjejunumanastomosisafterjejunalhemorrhagealsobelongstothiscategory.Massivehemorrhageisreferstowithinafewhoursofbloodlossthan1000mlorcirculatingbloodvolume20%,itsmainclinicalexpressionismetathesisand(or)blackstool,oftenaccompaniedbyareductioninbloodvolumeinducedacuteperipheralcirculatoryfailure,isacommondisease,themortalityrateisashighas8%~13.7%.
2,theepidemiologicaldata:
(1)Duodenalulcer,gastriculcer,acutegastriccolossallesions,malignanttumor,esophagealvariesChineseisthemaincauseofuppergastrointestinalhemorrhage,accountedfor31.2%,15.2%,12%,11.7%,11.3%;
(2)2000comparedto2006and2006to2011,aduodenalulcer,gastriculcer,acutegastriccolossallesion,esophagealvaries,malignanttumorratiois32.3%,15.1%,12.1%,7.2%,12.5%and29.7%,15.4%,11.1%,15.3%,10.9%;
(3)Malepatientsweremorethanfemalepatients,theratiois3.25:
1;
(4)theelderlymaincauseofuppergastrointestinalbleedingingastriculcer,cancer,acutegastritis,duodenalulcer,esophagealvaries,children'
smaincauseofuppergastrointestinalhemorrhageinduodenalulcer,gastriculcer,acutegastriccolossallesion.Conclusionspepticulcer,acutegastriccolossallesion,malignanttumor,esophagealvariesChinaisthemaincauseofuppergastrointestinalhemorrhage.
Ⅱ.LearningObjective
1.Tounderstandthebasicknowledgeofupperdigestivetracthemorrhage.
2.BefamiliarwiththeIdentificationofupperdigestivetracthemorrhagetreatmentandsymptom.
3.Tograsptheupperdigestivetracthemorrhagepatientsofholisticnursingcare.
Ⅲ.AnatomyandPhysiology
1.pathologicalanatomy:
Upperdigestivetractbyoralcavity,pharynx,esophagus,stomach,duodenum.
2.etiology:
The1uppergastrointestinaldiseases:
(1)foresophagealdiseases
(2)theduodenaldiseases
(3)jejunadisease
The2portalhypertension:
(1)avarietyofcompensatelivercirrhosis.
(2)portalveinobstruction
(3)hepaticvenousobstructionsyndrome.
The3adjacentorgansortissuesofthegastrointestinaltractdisease:
(1)bilioustractbleeding
(2)uremia.
(3)withstressulcer.
3.clinicalmanifestation:
(1)hematemesisand(or)black
(2)hemorrhagicperipheralcirculatoryfailure
(3)toxemia
(4)anemiaandHemogra
4.laboratoryexamination:
1.laboratorytests
2.specialinspectionmethod
(1)endoscopy
(2)selectivearteriography
(3)X-raybariummealexamination
(4)radiosondescan
Ⅳ.Caseprofile
1.Introducingthecase
(1)Hematemesis,melenafor3days
(2)presenthistory:
onabdominaldistensionpatientsaweekoneatinghardafter,afterdefecationcanalleviatethesymptoms,notthediagnosisandtreatmentof.3daysagodefecateinsuddenfeelingnausea,vomitingCoffeelikestomachcontent1,weightabout300-400ml,followedbyredbrownbloodystoolandtarrystoolinatotalof5times,averageweightofabout200ml,withdizziness,weakness,sweating,abdominalpain,abdominaldistension,tenesmus,nochestpain,tightnessinthechest,palpitation,chills,feveranddiscomfort.Inourhospitalemergencydepartmentvisits,checkingbloodroutinetest:
WBC17.15*10^9/L,RBC3.24*10^9/L,HB101g/L,PLT221*10^9/L,totheantiinfection,antiacid,hemostatic,nutritionsupporttreatment.Sincesincetheillnessofpatients,spirit,sleepgood,poorappetite,stoollikeappeal,normalurine,recentwithoutsignificantchangesinbodyweight.
(3)History:
usuallyishealthy,deniedthe"
hepatitis,tuberculosisandotherinfectiousdisease,"
vaccinationhistoryisunknown."
Hypertension,diabetes,coronaryheartdiseaseanddenied"
andotherchronicdiseases,denyoperation,traumahistory,deniedfoodanddrugallergyhistory,denythehistoryofbloodtransfusion.
(4)socialandpsychologicalstateinpatientswithstableemotion,socialsupportofgood
(5)therelevantexamination:
a.theblood:
WBC:
9.66*10^9/L;
Hb:
67g/L;
PLT:
144*10^9/L;
NEUT:
65.4%
b.fecalexamination:
theappearanceofredbrown
5-10/HPF;
RBC:
20-30/HPF;
ob(+)
2.treatment
(1)thegeneraltreatment:
absolutebed,oxygeninhalation,ECGandbloodpressuremonitoring,fast.
(2)drugtherapy:
acidsecretioninhibitors.Inhibitoryeffectofdrugsinhibitinggastricacidsecretionofgastricacidsecretion,increasedgastricpHvalue,isconducivetothebleedingandpreventre-bleeding.Commongastricacidsecretioninhibitorswithprotonpumpinhibitorssuchasomeprazole40mgeachtime,2timesdailyintravenousinjectionorinfusion.
(3)supplementbloodcapacity:
immediatelycheckedbloodtypeandbloodmatching,theestablishmentofaneffectivechannelintravenousinfusionassoonaspossible,supplementbloodcapacityassoonaspossible.Inthematchingprocess,tolosebalanceliquidorglucosesaline.Improvementofacutehemorrhagickeyperipheralcirculatoryfailureistobloodtransfusion,thegeneralredbloodcelltransfusionconcentration,seriousactivityhemorrhageconsiderwholebloodtransfusion.
Thefollowingconditionsforemergencybloodtransfusionindications:
a.changethepositionsyncope,decreasedbloodpressureandheartrate;
b.andhemorrhagicshock;
c.hemoglobinbelow70g/Lorhematocritislowerthan25%.Bloodtransfusionasimprovehemodynamicsandanemiapatientsaroundanddecide,urinevolumeisareferencevalue.Shouldpayattentiontoavoidtheinfusion,transfusiontoofast,toomuchandcausepulmonaryedema,theoriginalheartdiseaseorelderlypatientswhennecessary,accordingtothecentralvenouspressureadjustinginput.
(4)parenteralnutritionsupport
Ⅴ.Identificationofpatient’sproblem
1.nursingdiagnosis
(1)bodyfluiddeficiencyanduppergastrointestinalmassivehemorrhage.
(2)activityintoleranceassociatedwithhemorrhagicperipheralcirculatoryfailure.
(3)thereisriskoftrauma,injuryofasphyxia,aspirationofesophagusandfundusofstomachmucouslongtimecompression,compressionofthreecavitytubeobstructionoftheairway,bloodorsecretionsintothetrachea.
(4)thelackofknowledgerelatedtothedeficiencyofuppergastrointestinalhemorrhagecausedbydiseasesandtheirpreventionknowledge.
2.nursingobjectives:
Shorttermgoals:
(1)withnosignofrecurrenthemorrhage,insufficientbloodvolumecorrected,stablevitalsigns.
(2)getenoughrest,dizziness,weaknessofnolitigation.
(3)upperairwaypatency,noasphyxia,aspiration,esophagealandfundicmucouswasnotduetoballooninjury.
(4)patientscansignrecognitionattheonsetofthedisease.
Longtermgoals:
(1)thepatientsbloodreturntonormalrange,nohematemesis,melena.
(2)exercisetoleranceincreasedgradually,thesafepointsactivities.
(3)patientswereabletobetterunderstandthedisease,andcaneffectivelypreventtherecurrenceofthedisease
3.nursingmeasures:
A.bodyfluiddeficiency:
(1)positionandkeeptheairwaypatency:
absolutebedrest,bleedingpatientssupineandlowerlimbwillbeslightlyraised,inordertoensurethebloodsupplytothebrain.Vomitingandheadtooneside,topreventsuffocationoraspiration;
whennecessary,negativepressureaspiratorforremovalofairwaysecretions,bloodorvomit,maintainairwaypatency.Giveoxygen.
(2)treatment:
immediatelyestablishveinchannel.Thestartofinfusionshouldbefast,centralvenouspressuremeasurementastheadjustmentoftheinfusionvolumeandinfusionratebasiswhennecessary.Avoidinfusion,transfusionoftoomuch,toofastandthecauseofacutepulmonaryedema,inelderlypatientswithheartandlungfunctionisnotcompletepersonespeciallyshouldpayattentionto.
(3)dietnursing:
acutemassivehemorrhagecomplicatedwithnausea,vomitingshouldfast.Asmallamountofbleedingwithoutvomiting,intothecool,bland.
(4)thepsychologicalnursing:
observationinpatientswithandwithouttension,fearorgriefandotherpsychologicalreactions.Interpretationofbedresttohemostasis,care,comfortapatient.Hematemesisormelenaafterthetimelyremovalofblood,dirt,inordertoreduceadversestimulationpatients.
(5)Observation:
a.vitalsignsobservation
b.spiritandconsciousness
c.observationofskinandnailbedcolor
d.preciseintakeandoutputrecord
e.observationofvomitandfecesnature,colorandquantityChanges
f.monitoringofserumelectrolyteandbloodgasanalysis
B.Pharmaceuticalcare
(1)NS250/500ml+somatostatin3MG,firsttosomatostatincontaining250μgintravenousinjection(10min),followedbymaintenanceofintravenousinfusionof12-24h.Theprocessofdripinfusionpatrolstoobservetodo,noadversereactions,suchas:
vertigo,tinnitus,blush,dripexcessivenausea,vomiting,shouldstrictlycontroltheinfusionspeed.
(2)Nexiumandotherdrugscancauserecurrentvomiting,difficultyswallowing,hematemesisormelena,ifsuchasituationshouldbereportedtoadoctorimmediately,checkregularlywithoutleukemia,goodoralcare,
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 个案 护理 英文